Low-Barrier Care (LBC) is an HIV care intervention designed specifically for people with HIV (PWH) whose complex needs keep them from engaging in standard Ryan White HIV care. Originally developed in Seattle, WA, as the Max Clinic, LBC comprises three essential but flexible core components (i.e., structural elements): 1) walk-in access to clinical care, 2) integrated intensive supportive services, and 3) facilitators and incentives to support continued care engagement. LBC reduces healthcare-system and social-determinant barriers to care using a client-centered approach. 

The original Max Clinic model has been shown to increase both care engagement and viral suppression among PWH with complex needs. It is considered a “Best Practice” by both the HRSA Ryan White HIV/AIDS Program and the Centers for Disease Control and Prevention. Key studies on the Max Clinic include:

• Dombrowski JC et al. The Max Clinic: Medical Care Designed to Engage the Hardest-to-Reach Persons Living with HIV in Seattle and King County, Washington. AIDS Patient Care STDS. 2018 Apr;32(4):149-156. doi: 10.1089/apc.2017.0313.  

• Dombrowski JC et al. HIV Care for Patients With Complex Needs: A Controlled Evaluation of a Walk-In, Incentivized Care Model. Open Forum Infect Dis. 2019 Jun 26;6(7):ofz294. doi: 10.1093/ofid/ofz294. 

• Beima-Sofie K et al. “It’s Me as a Person, Not Me the Disease”: Patient Perceptions of an HIV Care Model Designed to Engage Persons with Complex Needs. AIDS Patient Care STDS. 2020 Jun;34(6):267-274. doi: 10.1089/apc.2019.0310.  

• Dombrowski JC et al. Implementation of Low-Barrier Human Immunodeficiency Virus Care: Lessons Learned from the Max Clinic in Seattle. Clin Infect Dis. 2023 Jul 26;77(2):252-257. doi: 10.1093/cid/ciad202.